VMD-928 Monotherapy and in Combination With Pembrolizumab to Treat TrkA Overexpression Driven Solid Tumors or Lymphoma

Official title

A Phase 1/2 Open-Label, Multiple-Dose, Dose-Escalation Study to Investigate the Safety, Pharmacokinetics, and Pharmacodynamics of VMD-928 as Monotherapy and in Combination With Pembrolizumab in Subjects With Solid Tumors or Lymphoma

Overview

This is a multicenter, open-label, Phase 1/2 study of orally administered VMD-928 monotherapy and in combination with pembrolizumab in adult subjects with advanced solid tumors or lymphoma that have progressed or are non responsive to available therapies and for which no standard or available curative therapy exists

Detailed description

This is an open-label, dose-escalation (Phase 1) and expansion (Phase 2) multi-center study conducted in five parts to identify the safe and pharmacologically active doses (MTD and/orRP2D) and regimen for oral VMD-928 monotherapy and in combination with a PD-1 inhibitor, pembrolizumab in cancer patients. An immunohistochemistry (IHC) assay specific for detecting TrkA protein in tumor tissue samples has been validated and is being used to detect TrkA protein expressions in patient tumor tissue samples at Pre-screening. The study is currently focusing on the top 5 solid tumor with the highest TrkA protein overexpression are: Head and Neck Cancers (HNC), Esophageal cancer, Lung cancers, Mesothelioma, and Pancreatic Cancer.

Interventions

• Drug VMD-928 100 mg Tablet
  Taken orally once daily for 21 days per 21-day cycle
• Drug VMD-928 Tablet and Pembrolizumab (200 mg)
  VMD-928 tablet (oral) starting at 300 mg daily for 21 days of 21-day cycle. Pemprolizumab at fixed intravenous dose of 200 mg once-every-21 days (per cycle) for max. 6 cycles.

Primary outcome measures

• Number and severity of treatment-emergent Adverse Events (Phase 1) [Time frame: First cycle (21 days per cycle)]
• To determine the recommended Phase 2 dose for VMD-928 (Phase 1) [Time frame: First cycle (21 days per cycle)]
• To determine the RP2D of VMD-928 in combination with pembrolizumab (Phase 1) [Time frame: First cycle (21 days per cycle)]
• Antitumor activity of VMD-928 in subjects with TrkA-driven tumors (Phase 2) [Time frame: Up to 18 months]
• Antitumor activity of VMD-928 in combination with pembrolizumab in subjects with TrkA-driven tumors (Phase 2) [Time frame: Up to 18 months]

Secondary outcome measures (4)

• Area under the plasma concentration versus time curve (AUC) of VMD-928. [Time frame: On Day 1 and Day 15 of Cycle 1 (each cycle is 21 days)]
• Peak plasma concentration (Cmax) of VMD-928. [Time frame: On Day 1 and Day 15 of Cycle 1 (each cycle is 21 days)]
• Incidence of Dose Limiting Toxicities. [Time frame: During the Cycle 1 (each cycle is 21 days)]
• Correlation between clinical antitumor and TrkA protein expression. [Time frame: Up to the end of the Cycle 2 (each cycle is 21 days)]

Eligibility criteria

Inclusion criteria

#. Histologically or cytologically confirmed diagnosis of any type of solid tumor malignancy or lymphoma:

Phase 1 Dose Escalation only: Subjects with

(A) any advanced solid tumors of

• Head and Neck Cancers ("HNC") (of any types),
• Esophageal cancer,
• Lung cancers (of any types),
• Mesothelioma,
• Pancreatic cancers,

Or,

(B) any NTRK1 gene fusion positive ("NTRK1+") solid tumors or lymphomas, that is relapsed, refractory or intolerant (R/R/I) to standard of care (SOC) and for which there is no approved or curative therapy. Additionally, patients must not be candidates for or have exhausted regimens known to provide clinical benefit, including hematopoietic stem cell transplantation in lymphoma patients if they are deemed transplant eligible.

Phase 2 Monotherapy and Combination with Pembrolizumab only:

Subjects must have

• TrkA-driven HNC, Esophageal, Lung, Mesothelioma, Pancreatic cancers; or,
• any NTRK1+ solid tumors or lymphoma\*, that is R/R/I to SOC.

Inclusion criteria

• Eastern Cooperative Oncology Group (ECOG) Performance Status: 0 or 1.
• Able to swallow and retain oral medication.
• Subjects must either have available archival tumor tissue samples, or consent to tumor tissue sampling prior to the first dose.
• Adequate organ system function as defined as follows:

• Absolute neutrophil count ≥1.5x10\^9/L
• Hemoglobin ≥9g/dL
• Platelets ≥100x10\^9/L
• PT/INR, PTT ≤1.5xULN
• Total bilirubin ≤1.5x ULN
• AST, ALT ≤2.5xULN
• Creatinine ≤1.2xULN for age, weight
• Calculated creatinine clearance or 24h urine creatinine clearance ≥60mL/min

Exclusion criteria

• Received chemotherapy having delayed toxicity within the last 14 days (six weeks for prior nitrosourea or mitomycin C).
• Received anticancer therapy with radiation, immunotherapy, and a biologic, surgery and/or tumor embolization within the past 2 weeks.
• Received an investigational anticancer drug within 14 days or 5 half-lives of the investigational agent, whichever is longer, prior to the first dose of VMD-928. Any exceptions to the above must be approved by the Sponsor Medical Monitor.
• Unresolved toxicity from previous anticancer therapy \> CTCAE Grade 1 (except alopecia or anemia) unless agreed to by both the Sponsor Medical Monitor and the Investigator.
• Known active infections including HIV disease.
• Currently pregnant, nursing, or planning to become pregnant during the course of the study.
• QTcF interval ≥ 480 msec.
• Class II, III, or IV heart failure as defined by the New York Heart Association (NYHA) functional classification system.
• Acute coronary syndromes (including unstable angina), coronary angioplasty, or stenting within the past 24 weeks.
• Unstable or uncompensated respiratory, hepatic, renal, or cardiac disease that would compromise the patient's safety or interfere with assessment of the drug.
• Psychological, familial, sociological, geographical, or other concurrent conditions that would interfere with safety evaluation, limit the patient's ability to follow the procedures in the protocol or otherwise jeopardize compliance with the protocol. Patients with uncontrolled major depression, bipolar disorder, or severe anxiety disorder are excluded.
• Patient has had or is currently having other malignant tumors within 3 years.
• Patients have multiple factors that affect their oral medication.
• Patients have long-term unhealed wounds or fractures.
• Patients have uncontrolled pleural effusion, pericardial effusion, or ascites that still require repeated drainage.
• Patients are taking the following drugs and can't stop them during the study:

• Tylenol or medicine containing acetaminophen (paracetamol).
• Antacids (e.g. TUMS, calcium carbonate, or magnesium hydroxide), proton pump inhibitors (e.g. omeprazole), H2 blockers (e.g. famotidine), or buffered vitamins.
• Epstein-Barr virus (EBV) negative nasopharyngeal carcinoma.

For Phase 2 only:

• Negative result on TrkA immunohistochemistry (IHC) assay.
• Have visceral crisis, defined as severe organ dysfunction and rapid progression of the cancer. (It is not about presence of visceral metastasis.)

For combination therapy with Pembrolizumab only:

• Serious adverse immune related adverse events (grade 3 or 4) with previous PD-1(L1) inhibitor therapy, that were symptomatic and required prolong immunosuppression (>6 weeks).
• Any grade Pneumonitis and Myocarditis related to prior PD-1(L1) inhibitor therapy.
• For subjects that received PD-1(L1) inhibitors before, there should be a washout period of at least 21 days between the last day of PD-1(L1) inhibitor and first day of study medications.
• Subjects who relapsed after prior treatment with PD-1(L1) inhibitors. Relapsed is defined as patients having best overall response of CR or PR after treatment with a PD-1(L1) inhibitor.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Sequential

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 14 centers

• Providence Medical Foundation (site 209) — Santa Rosa
• Hartford Hospital (site 210) — Hartford
• The George Washington University Cancer Center (site 212) — Washington D.C.
• Holy Cross Hospital (site 213) — Fort Lauderdale
• Memorial Cancer Institute at Memorial Healthcare Systems (site 132) — Pembroke Pines
• Englewood Hospital and Medical Center (site 202) — Englewood
• Summit Medical Group (site 205) — Florham Park
• Atlantic Health System, Morristown Medical Center (site 124) — Morristown
• … and 6 more centers

Puerto Rico · 1 center

• PanOncology Trials, Hospital Oncologico - Puerto Rico Medical Center, Río Piedras (site 20 — San Juan

Identifiers

NCT: NCT03556228 · VMO-01C

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗